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Henry, Melissa

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Many nursing students experience anxiety in the clinical setting. Increased anxiety impairs students’ ability to learn and can have a negative effect on patient safety. To promote student learning and patient safety, it is imperative that nurse educators identify and implement strategies to decrease nursing students’ anxiety. The purpose of this embedded mixed methods study was to determine if reflective journals are an effective strategy to address the problem of student anxiety. Participants were randomly assigned by their clinical group to either write guided reflective journals, non-guided reflective journals, or no reflective journals during their first clinical rotation where they provided patient care. Participants in the quantitative strand of this study (n = 20) completed an online pre-test to measure their state and trait anxiety prior to beginning their first clinical rotation. After completing the four-week clinical rotation participants completed a post-test to measure their state anxiety. Descriptive and inferential statistics were used to analyze the quantitative data. Participants in the qualitative strand of the study participated in an interview with the researcher. Magnitude coding was used to determine the participants’ perception of the impact of writing reflective journals on their anxiety. In Vivo coding was used for the first cycle of coding for the qualitative data about participant experiences with writing reflective journals. Common themes were then identified There was a decrease in state anxiety between pre-test and post-test data collection for all participants (p < .05). The decrease in state anxiety was statistically significant for participants in the guided reflective journal group (n = 9, p = .006) and the non-guided reflective journal group (n = 6, p = .024). The decrease in state anxiety was not statistically significant for participants in the control group (n = 5, p = .254). Participants who wrote guided or non-guided reflective journals thought the journals decreased their anxiety associated with the clinical setting. Participants who did not write journals thought they would have benefitted from having a journal assignment. Four themes were identified related to experiences with writing journals for all participants who wrote reflective journals: allowed time, identified feelings, assisted with processing, and increased confidence. The findings of this study support the use of reflective journals as an intervention to decrease nursing students’ anxiety associated with the clinical setting. Key Words: anxiety, reflective journals, nursing students, clinical setting, mixed methods


195 pages

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